Will Congress Keep the Two-Tier System of Abortion?

BOSTON — Boston.--All through the debate about abortion and health care reform, many members of Congress have been talking about the status quo as if it were a peaceable kingdom in the abortion wars.

They have described that ''state'' longingly as a utopia where sleeping dogs lie. Where boats don't rock. Where bills pass.

Leaders in both houses have tried to devise some compromise that would fit within those borders. They wanted a place where a reform bill would be safe from the cross fire of pro-life and pro-choice opponents. But it isn't possible.

The problem is that the existing state of abortion policy is a double standard of health care. At the height of the controversy in the 1980s, we established a two-tier system of abortion. One for the poor, another for the rest. One public, another private.

On the top tier, we have a private system of insurance that provides abortion coverage for 70 percent of the female clients.

On the bottom tier, we have a public system of insurance, Medicaid, that denies abortion coverage to all but a handful of poor women. We compromised by compromising the poor.

Now we are in the midst of debating health care reform. But among the things that it is supposed to reform is two-tiered systems. Everyone has been promised the same basic package of benefits.

Under this promise, either middle class women who have abortion coverage would lose it, or poor women who don't have coverage would gain it. There would be more coverage or less. Pro-life or pro-choice supporters would win or lose.

This is exactly the sort of crossroad that makes some politicians feel a little motion sickness.

Dick Gephardt expressed the general queasiness when he said wistfully, ''I think both sides realize we can't re-decide the abortion issue in this bill and that we ought to try to, as much as we can, make it neutral with regard to abortion.''

But, as he discovered, neutral is a word that does not come easily in the abortion wars. We are re-deciding the abortion issue along with the entire health care system.

Abortion is either a health care service or what James Wagoner of the National Abortion Rights Action League calls a ''pariah service.'' Poor pregnant women in need of abortions are either part of the system or pariahs.

By late Wednesday night, even Mr. Gephardt had to give up the search for a political safety zone. Both the Gephardt and Mitchell bills now treat abortion as part of pregnancy-related health care. But the whole question will return again in a knockdown fight over floor amendments.

The so-called ''compromises'' floating around include some that would deny abortion coverage to any woman who gets a government subsidy.

The welfare poor and working poor would remain ''unreformed'' in the two-tier world. Other compromises would allow whole plans and employers to opt out of coverage.

As a believer in choice, I approve of the conscience clause that allows a doctor or nurse to opt out of performing abortions. If a woman wants to strike abortion from her own policy, fine.

But neither the government nor her employer should be allowed to opt out for her.

Before we buy any ''compromises,'' let's remember the real state of the status quo in the abortion controversy. Pro-life and pro-choice forces have not, as we might wish, signed a cease-fire and joined hands to reduce the demand for abortion.

Since Mr. Clinton's election, the argument hasn't been muted, it's just moved. The anti-abortion movement has switched from trying to make abortion illegal to trying to make it impossible.

One way is by blocking access to clinics, terrorizing women and, need I remind you, murdering doctors and escorts.

In a CNN poll last week, 8 percent of Americans agreed that using force to prevent abortion was justifiable. Three percent said killing a doctor was justifiable.

That's a small percentage, but a whole lot of people willing to fight to somebody else's death.

Another way is by controlling purse strings and health care reform plans. Especially by refusing insurance to the women who are least able to pay for their own abortions.

In short, the current ''state'' is not my idea of a tranquil kingdom. As Kate Michelman of NARAL says, ''Don't rock the boat? What boat are they talking about? This one's already rocked.''

As the debate over health care goes into high gear, Congress will have to move one way or the other.

Any basic health care package worthy of the name ''basic'' must cover the most common surgical procedure in the country.

Any health care reform worthy of the name ''universal'' has to cover women. That includes the poor and the pregnant.